11-11 940
11-11 940
| Board of Vet. App. | Aug 31, 2016Background
- Veteran served in the U.S. Army (Jun 2000–Jun 2004) and has service connection for status post right ring finger fracture, assigned 0% effective Feb 22, 2010 (RO decision Sep 2010).
- Veteran appealed the 0% rating, asserting disability involves his right hand (not only ring finger) with pain, cramping, numb fingertips, and nerve damage.
- Board previously remanded (Sep 2014) for additional VA examinations addressing orthopedic and neurological manifestations; subsequent VA exams (Oct–Dec 2015) were incomplete or performed by a physician assistant, and neurological testing was postponed.
- A March 2016 VA electrodiagnostic treatment consult showed mild right median neuropathy (carpal tunnel) but was treatment-oriented and not considered adequate for rating development.
- October 2015 examination left scar information incomplete and did not differentiate neurological vs orthopedic causes; TDIU claim is inextricably intertwined with the increased rating claim.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| Whether the Veteran is entitled to an initial compensable rating for status post right finger fracture / right hand disability | Disability is of the right hand (not just ring finger) with pain, cramping, numbness, and nerve damage warranting higher rating | RO awarded 0% for right ring finger fracture; current record lacks adequate VA physician neurological exam to support higher rating | Remanded for a VA neurological exam by a physician and re-adjudication; development inadequate so no final decision made |
| Whether a separate rating for scars related to the right hand/finger disability is warranted | Scars may be painful/unstable and could support separate rating | October 2015 examiner failed to document scar number, location, size, diagnosis linkage, or pain/instability | Remanded for examiner to describe scars (location, size, pain/instability) so Board can assess separate rating |
| Whether there is neurological impairment (e.g., carpal tunnel) related to the service-connected injury | Veteran reports symptoms consistent with neuropathy; March 2016 electrodiagnostic study suggests median neuropathy | VA exam did not adequately evaluate neurologic manifestations or relate them to the 2001 in-service fracture; March 2016 consult is treatment, not exam for rating | Remanded for physician neurological exam to determine presence/severity of neuropathy, relation to service injury, and whether diagnostic code for neurologic manifestation is appropriate |
| Whether TDIU is warranted based on service-connected disabilities | Veteran contends unemployability due to service-connected hand problems | TDIU claim depends on proper disability rating development; cannot decide until rating development complete | Remanded as claims are inextricably intertwined; readjudicate TDIU after requested development |
Key Cases Cited
- Stegall v. West, 11 Vet. App. 268 (Board must ensure compliance with remand orders)
- Harris v. Derwinski, 1 Vet. App. 180 (claims are inextricably intertwined when one claim could affect another)
- Kutscherousky v. West, 12 Vet. App. 369 (appellant may submit additional evidence after remand)